Investigators Add New Insights to Lyme Disease Diagnosis and Treatment

With the number of reported Lyme disease infections expected to reach record highs in 2017, Massachusetts General Hospital researchers are helping to meet the need for new diagnostic tools and treatments.

The work of John Branda, MD, and Allen Steele, MD, was recently featured on the Mass General Giving Website. Here is a brief summary of the article, which you can find in full here.

A New Test for Lyme Disease

Lyme disease is caused by the bacterium Borrelia burgdorferi (B. burgdorferi), which is transmitted to humans through the bite of an infected blacklegged tick, commonly known as a deer tick. The tick must be attached for 36 to 48 hours or more before the Lyme disease bacterium can be transmitted.

As with many infectious diseases, early detection plays a key role in treatment. John Branda, MD, associate director of the Clinical Microbiology Laboratory at Mass General, and his colleagues are developing a new way to diagnose Lyme disease, as current blood tests frequently yield false negative results in the weeks after infection.

The team’s new testing technique starts with a blood sample that is first amplified by polymerase chain reaction technology, a method that can make the genetic material of a pathogen such as B. burgdorferi more easily identifiable.

Then the blood is then scanned with magnetic resonance imaging, which can quickly pick up the Borrelia DNA. The test, known as T2MR, was able to detect B. burgdorferi in blood samples from patients who were suspected of having Lyme disease but had tested negative using traditional techniques.

Genetic Factors

In a separate research study, Allen Steere, MD, a Mass General rheumatologist and the researcher who led the team that first identified Lyme disease in the 1970s, is exploring why some patients do not recover from the disease even after receiving a course of antibiotics.

While the antibiotics are able to clear the infection, some patients still experience pain, fatigue and neurocognitive symptoms. A few patients can go on to suffer from antibiotic-refractory Lyme arthritis — a painful inflammation of the joints that long outlasts the infection.

In these patients, there is mounting evidence that Lyme disease triggers an abnormal immune response, which in turn attacks the tissues of the joints, even after B. burgdorferi has been cleared by antibiotics.

Dr. Steere believes that many more severe cases may result when people with a specific genetic profile encounter a particularly virulent strain of the bacterium.

When genetic susceptibility and virulent B. burgdorferi strains combine, as they do in as many as 20% of people of Caucasian ancestry who are infected with Lyme disease, ideal conditions are created for an amplified and maladaptive inflammatory response that can attack joint tissues.